Loading...
1986, 12-23 Permit App: 87000037 FurnacecO MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 4S r l5oe /3-/vgq I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not.presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR /� DATECATION /A .3 G/Gi Project It -Rfs"��C.lJg7 O � Owner's Name Last First MI 4)/1n(/7a Al tilA/)/ I.1 Project Addr (Street Name & Number _ /5dl ? .0 mg � City Sljd 4—Li Z— State (1 .. Subdwis n/ Plat Name -Wm/ 2 Assessors Parcel M /554j2.— (I 61 Lot / Block' Plat N Applicant Address City State Zip Phone Business Phone Contractor N» 4do ("4"—)4 7/1//1 it- /C° Add Te'r 4;7' City 9,d A ,r2 b= State br) 4 Zip 99a /Q Phone -, 3 `Y--/y7s . ContactLicense A ' 1c' tt ,2,22W S''eia14- /71 /22.. Business Phone 39C/i-,--:75---- 5 '/ -v7 r .P Describe Work eels//8I Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous Dryer Range Gas Log Gas Wate Htr. Solid Fuel/ Wood Stove Air Handling Units 0-10,000 CFM 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System -- 1-10000,,0000BB'TU�/ � 106,C.00 + BTU --nn '''' s� Qt. ,, �//j am ---/ !")7-7/ ' I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not.presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR /� DATECATION /A .3 G/Gi